[Phakomatosis: anatomo-clinical expressions of urological interest]. / Facomatosi: espressioni anatomocliniche di interesse urologico.

Up to date etiopathogenetic knowledge of phakomatoses allows a more rational classification as compared to the known ones, based on anatomopathological and/or clinical features. Some genes have been identified, which are correlated with neurofibromatoses, tuberous sclerosis and other conditions, through general biologic mechanisms (derivatives of the embryonic neural crest; nerve growth factor and its receptor; oncogenes and antioncogenes, etc.). A prenatal predictive value from those genetic connections can also ensue. The new diagnostics, both by imaging and by laboratory techniques, may affect the therapeutic choices, as for as urological involvement is concerned.

[New findings regarding neuroreceptors in the lower urinary tract]. / Nuove acquisizioni sull'assetto neurorecettoriale del tratto urinario inferiore.

In the field of the neuroreceptors of the lower urinary tract, knowledge is being increased by some recent experimental findings, such as muscarinic subtypes, adrenergic and serotoninergic selective receptors. Moreover, the role of peptidergic receptors (VIP, CGRP, TKs, SP, ecc.; neuropeptide release from peripheral endings of capsaicin-sensitive nerves) has been suggested and investigations are in progress.

[Central and peripheral neuromodulation of ejaculation. An updating contribution]. / Neuromodulazione centrale e periferica dell'eiaculazione. Contributo d'aggiornamento.

Some recent results of both experimental and clinical researches have brought to the attention the role of new neurotransmitters and neuroreceptors involved in the process of seminal ejaculation. In the central neurochemical system (neurotransmitters and neurohormones), besides the known monoamines, several aminoacids, peptides, steroids, kinins, PGs--some of which produced by the glia--have been recently evidenced. Among the peripheral receptors, besides the muscarinic and adrenergic ones, some neuropeptidic (VIP, Neuropeptide Y, endogenous opioids, etc.) take part in the effectorial process of ejaculation. Many pharmacological agents may interfere with the ejaculation, at both central and peripheral levels.

[Cystic kidney disease in the adult. Update]. / Malattia cistica renale dell'adulto. Contributo d'aggiornamento.

Genetic changes on the extracellular matrix of nephron basal lamina seem to underlie the pathogenesis of renal cystic disease, as also confirmed by experimental results. The cysts behave as dynamic structures and repeat some physiological features of the nephron segment which gave origin to them. These properties reflect, for instance, on the pharmacokinetics of antibacterial drugs. New imaging techniques detect more and more asymptomatic cystic formations of very little volume. Moreover, a better definition of some complications, such as haemorrhage and infections, is afforded by the RX- and RM-CT and the use of specific radiopharmaceuticals (67Ga-citrate, 99mTc-sulfur-colloids, 111In-labeled leucocytes).

Retroperitoneal fibrosis: some new acquisitions about pathogenesis and diagnostics.

Some newly proposed pathogenetic theories for retroperitoneal fibrosis refer to immune-related mechanisms; they are reviewed and discussed. In the field of imaging techniques, some MR paramagnetic contrast media, such as "ferrite" compounds and Gd-DTPA, and 67Ga-scintiscan, 111In-labelled leukocytes scan, 99mTc-labelled colloids contribute to answering the request to differentiate the still active cellulitis from an established fibrosis. 131I-MIGB scan identifies the carcinoid-related retroperitoneal fibrosis.

[The role of venous drainage in uro-genital pathology]. / Ruolo del drenaggio venoso in patologia uro-andrologica.

Problems of venous hemodynamics underlie several uro-andrological conditions, such as idiopathic or acquired varicocele, erective impairment from venous leakage, intercaval collateral pathways induction from venous obstructive processes (thrombosis, embolism, external caval compression). Particularly, the renal venous thrombosis seems to be ascribed to a primary membranous glomerulo-nephritis rather than to a reverse mechanism. Moreover, the caval obstruction proximal to the hepatic confluence can induce a portal system's impairment, such as in the Budd-Chiari syndrome. Some diagnostics (US, RX-CT, RM-CT) afford to day a better evidence of the underlying venous imbalances in the aforesaid conditions.

[Occult carcinoma in urology. Nosography and diagnosis]. / Carcinoma occulto in urologia. Nosografia e diagnostica.

The term "unknown carcinoma" may be referred to any tumour that is not revealed by clinical examination or by routine diagnostic measures; the same term can indicate metastases whose source remains unknown until revealed by autopsy. The definition of the tumour histotype is mandatory for a correct choice of curative or a palliative treatment; therefore, a recognition of primary tumour should be cunningly aimed at. With regard to imaging diagnostics, some highly paramagnetic molecules for RM will shortly be available; with regard to nuclear medicine, some gamma-releasing immuno-specific markers reacting with tumour-associated antigens are also made available. Laboratory advances nowadays afford a better definition of biopsy samples, namely monoclonal antibodies versus cytospecific antigens and/or tumour-associated antigens; immuno-histochemical markers, such as anti-AFP and anti-HCG monoclonals, that detect the testicular source (germinal tumours) of a highly undifferentiated retroperitoneal mass; etc. It seems therefore possible the foresee a reduction in the incidence of "unknown" carcinomas.

[Tumors of the adrenal medulla: nosologic profile and diagnostic technics]. / Tumori della midollare surrenale: inquadramento nosologico e tecniche di diagnosi.

A nosologic re-arrangement of medullo-adrenal neoplasms has been looked for in this article, with particular regard to their common relationship to the complex histogenic system descending from the neuroectoderma-neural crista. The morpho-biologic features of these clinical entities are also reviewed, as well as the up to date laboratory and imaging techniques, with a stress on the high sensibility and specificity levels afforded, e.g., for some of these tumours by selected radio-isotopic examinations, due to their histogenetic, thereby biologic peculiarities.

[Tumors of the adrenal cortex. Physiopathologic basis of current diagnosis]. / Tumori del corticosurrene. Basi fisiopatologiche della diagnostica attuale.

A survey of functional and pathological features of adrenal tumours and of the pathogenetic pathways of related hormonal syndromes is presented. The up-to-date diagnostic means, with particular stress on nuclear techniques, are discussed.

Ureteral involvement in the Churg-Strauss syndrome: a case report.

We report a case of the Churg-Strauss syndrome with bilateral ureteral stenosis, secondary obstructive uropathy and anuria. The literature regarding urological implications of this disease is reviewed, and the surgical and medical management of our case is detailed.

[A case of rupture of the testis]. / Su di un caso di frattura del testicolo.

A case of traumatic rupture of the testis is presented in which the conservative surgery was successful. The results of the ultrasonographic evaluation and of the scanning with Tc 99, executed long after the operation, are presented. The importance of an early explorative operation in all cases of post traumatic scrotal swelling is stressed. On account of the youth of most patients, the importance of a conservative surgical approach is emphasized.

[Vesico-renal reflux caused by neurogenic bladder from spina bifida in childhood]. / Il reflusso vescico renale secondario a vescica neuropatica da spina bifida in età pediatrica.

The authors report their experience related to 35 cases of neuropathic bladder examined during the last 12 months. They discuss the method followed for the study of each patient. Particularly they underline the importance of: scintiscan in the valuation of the renal function and urodynamic tests for a better knowledge of vesical disfunction. In the patient with vesicorenal reflux they propose two kinds of treatment (medical or surgical), selected after a complete valuation of radiologic, functional and urodynamic tests. They underline the importance of the pharmacological treatment, single or associated with surgical operation, in the patients with reflux and with a low vesical compliance and/or hyperreflexic bladder. Finally the Authors discuss the antireflux surgical techniques that they prefer and that have consented them to obtain excellent results.

[Omentoplasty and a temporary internal stent in the treatment of recurrent peri-pyelo-ureteritis. Surgical technic. Apropos of a case]. / Omentoplastica e tutore interno a dimora temporanea nel trattamento della peripieloureterite recidiva. Nota di tecnica chirurgica. A proposito di un caso.

Repetitive surgery on the upper urinary tract calls for extensive and sometimes difficult dissection, therapy exposes to the risk of vascular and nervous injury, as far as tissue trophism is concerned, moreover to secondary severe perivisceral fibrosis. The ureter is particularly liable to such early or late damages. The use of a self-retaining stent, even for a long period of time, and of a pedicle omental graft wrapping ensures a better recovery and the prevention of fistulae or strictures from secondary retroperitoneal fibrosis.

[Diagnostic problems in non-acute prostatitis: experience in 150 cases]. / Problemi diagnostici nelle prostatiti non acute--una esperienza di 150 casi.

The rules for a diagnostic approach to non-acute prostatitis, as applied during a one-year trial in this Division of Urology, are reviewed and their results on a clinical ground of 150 cases are discussed. In fact, this clinical conditions is apt to present often some problems, as far its cure is concerned, due to its variety of symptoms, and not seldom to un-correct previous therapeutic approach, for defect of a precise diagnostic appraisal.

Isolation of Chlamydia trachomatis from the prostatic cells in patients affected by nonacute abacterial prostatitis.

To assess the presence of Chlamydia trachomatis in nonacute abacterial prostatitis 30 patients with urethral cultures positive for Chlamydia trachomatis underwent microbiological studies, including cultures of transrectal aspiration biopsies of the prostate. Chlamydia trachomatis was isolated from 10 of the prostatic specimens (33 per cent). In 3 cases a nonspecific cytopathogenic effect caused the destruction of the tissue cultures. Our findings demonstrate that Chlamydia trachomatis may cause ascending infections of the prostate and that this microorganism may have an etiological role in the pathogenesis of nonacute abacterial prostatitis.

[Postoperative uretero-vaginal fistula in a duplicated excretory system]. / Fistola uretero-vaginale postoperatoria in sistema escretore duplice.

A case is presented of uretero-vaginal fistula following hysterectomy for multiple fibromatosis. Duplicity of the left urinary tract, with caudal ectopy of ureteral opening of the branch draining the upper renal pole, could explain "a posteriori" some singularities of the clinical behaviour, i.e. combination of both controlled micturitions and continuous urinary loss "per vaginam" with seemingly normal urography. Postoperative chromocystoscopy afforded the correct diagnosis and surgical repair was followed by uneventful recovery. Preoperative assessment by urography and cystoscopy is therefore recommended prior to undertaking pelvic surgery, in order to promptly recognise complications to urinary tract, should they occur.

[Epidermoid cysts of the testis: conservative treatment?]. / La cisti epidermoide del testicolo: trattamento conservativo?

The epidermoid cyst of the testis is a monolayer teratoma with no malignant character, when pure. Therefore, its recognition on the basis of macroscopic and freeze histologic grounds should allow a conservative surgical removal, with saving of the testis. Out of the more or less 150 reported cases, about 85% have been treated by orchiectomy, about 15% by either enucleation or partial orchiectomy. In no case except one, a more thorough histologic examination of the removed cyst, malignant structures have been observed. In no case, with a follow-up from a few months to more than 15 years, a recurrence occurred. Two cases are presented and discussed, in which a conservative choice was made and clinical follow-up carried out.

[Advantages and disadvantages of peripheral anesthesia (subarachnoid and peridural) in urological surgery]. / Vantaggi e svantaggi delle anestesie periferiche (subaracnoidea e peridurale) in chirurgia urologica.

The pros and cons of spinal anesthesia for urological surgery are discussed and the technical details described of both subarachnoidal and peridural blocks, as they are routinely performed in the author's experience. An evaluation and a comparison on the two techniques give place to the following remarks: spinal anesthesia, not higher than L4-L5, is suitable for surgery on the lower urinary tract and male genitalia, as far as reach and level are concerned; it ensure lesser blood losses because of its know effects on vascular regulation; the awakeness of the patients ensures a quicker recognition of possible complications; peridural, as compared with subarachnoidal block, affords better bleeding control, lesser side effects, a more prolonged anesthesia.

[Transurethral prostatic adenomectomy]. / Adenomectomia prostatica transuretrale.

On the ground of the clinical experience of transurethral resection of the benign hypertrophy of the prostate performed in the Division of Urology during the last ten years, the technical aspects and problems of the procedure are discussed, chiefly the low-pressure irrigation of the operative field for the prevention of vesical damages and of the water-syndrome. The choice of the transurethral technique is dependent chiefly on the weight of the adenoma, on the duration of its removal and the related problems; it is also dependent on the availability of both proper instrumentation and operators. The lesser all-over surgical traumatism and blood loss, the precocious getting out of bed, the shortening of hospitalisation make T.U.R. particularly suitable for high risk patients. To conclude with, the clinical, personal and social advantages of this procedure depend on the correctness of its choice following the criteria which have been referred to.